Clinical Fellow.
Resident Assistant.
Obstet Gynecol Surv. 2020 Dec;75(12):747-756. doi: 10.1097/OGX.0000000000000848.
Gestational trophoblastic disease (GTD) is associated with increased mortality and morbidity in women of reproductive age, if managed in a suboptimal way, left untreated, or diagnosed after the development of extensive metastases.
The aims of this study were to review and compare the recommendations from published guidelines on these tumors of placental origin.
A descriptive review of guidelines from the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the European Society for Medical Oncology, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on GTD was carried out.
All the guidelines agree that suction evacuation is the optimal management for hydatidiform molar pregnancy and that chemotherapy, either single-agent (for low risk) or multiagent (for high risk), is the preferred treatment modality for choriocarcinoma. There is also a consensus that a future pregnancy should be avoided during follow-up; therefore, an effective contraception method should be used. All medical societies recommend the registration of such patients to GTD screening centers, endorse the use of International Federation of Gynecology and Obstetrics 2000 scoring system, and mention that the diagnosis of gestational trophoblastic neoplasia (GTN) should be based on the clinical presentation (from the genital tract and the metastatic sites) and the human chorionic gonadotropin evaluation. Additionally, all 4 medical societies recommend the surgical management of placental site trophoblastic tumors or epithelioid trophoblastic tumors, as chemotherapy is less effective in these cases. However, there is controversy regarding the appropriate follow-up after the treatment of hydatidiform mole, the administration of anti-D immunoglobulin, the time of oxytocin infusion, and the salvage regimens that may be used in cases of resistant or recurrent GTN.
There is need for consistent international practice protocols, which will lead to an earlier diagnosis and eventually to a more effective management of GTD worldwide and decrease in the recurrence rate and in the associated morbidity and mortality.
如果处理不当、未经治疗或在广泛转移后诊断出妊娠滋养细胞疾病（GTD），会导致育龄妇女的死亡率和发病率增加。
本研究旨在回顾和比较来自皇家妇产科医师学院、国际妇产科联盟、欧洲肿瘤内科学会和澳大利亚皇家妇产科学院出版指南中关于这些胎盘起源肿瘤的建议。
对皇家妇产科医师学院、国际妇产科联盟、欧洲肿瘤内科学会和澳大利亚皇家妇产科学院关于 GTD 的指南进行了描述性综述。
所有指南均认为抽吸清除术是葡萄胎的最佳治疗方法，而化疗（低风险时为单药治疗，高风险时为多药治疗）是绒毛膜癌的首选治疗方法。还有一个共识是在随访期间应避免再次妊娠；因此，应使用有效的避孕方法。所有医学协会都建议将此类患者登记到 GTD 筛查中心，支持使用国际妇产科联盟 2000 评分系统，并提到应根据临床表现（来自生殖道和转移部位）和人绒毛膜促性腺激素评估来诊断妊娠滋养细胞肿瘤。此外，所有 4 个医学协会都建议对胎盘部位滋养细胞肿瘤或上皮样滋养细胞肿瘤进行手术治疗，因为化疗在这些情况下效果较差。然而，对于葡萄胎清除术后的适当随访、抗-D 免疫球蛋白的使用、催产素输注时间以及耐药或复发 GTN 可能使用的挽救方案等问题，仍存在争议。
需要制定一致的国际实践方案，这将有助于更早地诊断出 GTD，最终在全球范围内实现更有效的管理，并降低复发率和相关发病率和死亡率。
